CMS Price Transparency Data

X-ray, pelvis

Facility: Adena Pike Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $280
Cash Discount Price: $186
vs. Medicare Baseline: 2.62x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Adena Pike Medical Center is $280. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $186. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.62x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$186

Average discount available for prompt cash payment at this facility.

Insurance Median

$280

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $186 (174%)

Insurance Median: $280 (262%)

Cash: $186 (174% of Medicare)

Ins. Median: $280 (262% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 262% of the Medicare baseline (a markup of 162%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$89 - $303	83%
Blue Cross Blue Shield	$89 - $321	83%
Buckeye Community Health Plan	$89	83%
Humana	$89 - $354	83%
Medical Mutual Of Ohio	$89 - $237	83%
Medigold	$89	83%
Molina	$89	83%
Care Source	$91	85%
Gateway Health	$123	115%
Molina Marketplace	$146	137%
Care Source Just4Me	$161	151%
Sidecar Health	$246	230%
Ohio Ppo Connect	$261	244%
The Health Plan	$261	244%
Cigna	$269	252%
Medical Mutual Of Ohio Supermed	$280	262%
First Health	$292	273%
Ohio Health Choice	$296	277%
UnitedHealthcare	$320	300%
Integrated Health Plan	$350	328%
Healthsmart	$354	331%
Multiplan/Private Healthcare Systems	$354	331%
Three Rivers Network	$354	331%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $186.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72170.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adena Pike Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72170.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.